Blue Cross

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Coordinating your reimbursement and regulatory strategies for a successful product launch

Ensuring appropriate third-party reimbursement for a new pharmaceutical or medical product involves an intricate interplay of considerations. There is no doubt that government and private payers have been under increasing...more

What You Say in Your SPD About Claims Processing Makes a Difference

Employers who self fund their medical plans often have contracts with their third party administrators about claims processing. Some of those contracts provide that the claims processor has discretion to decide claims; others...more

Health Law Insights Newsletter - Issue 8 - April 2016

McCarter & English, LLP’s Health Care Group presents Issue 8 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - New Payment Model for Part B Drugs Proposed -...more

None Of Your Business: Eleventh Circuit Enters A Gray Area For Contract Liability Exclusions

Businesses have responsibilities; they buy liability insurance to cover losses that arise if they fail to perform them all. Businesses also “assume” responsibilities under contracts; those responsibilities are typically...more

Sullivan & Worcester Files Amicus Brief on Behalf of Major Brand Companies Supporting EPA’s Clean Power Plan

WASHINGTON, DC – April 1, 2016 – Sullivan & Worcester today filed an amicus brief on behalf of four global brand companies with significant energy footprints in nearly every state in the country in the U.S. Court of Appeals...more

Collecting Another Supreme Win for ERISA Preemption - Court in Gobeille Invalidates Vermont Data Collection Law

The U.S. Supreme Court decided the case of Gobeille v. Liberty Mutual Insurance Co. last week, in which the Court invalidated a Vermont health care data collection law as being preempted by the Employee Retirement Income...more

The New Face of Commercial Crime - Cybersecurity Risks for Companies and their Directors

The threat of commercial crime against companies is transforming. Technology has created new and innovative ways for fraudsters to exploit individuals and companies through cyber attacks. This new face of fraud can give rise...more

Medicaid Update - January 2016

Welcome to the inaugural issue of "Manatt on Medicaid: Monthly Expansion Recap," a new companion publication to Manatt's weekly health reform highlights newsletter. For those of you laser-focused on Medicaid expansion, the...more

Issue 96: Happy Holidays - Cadillac Tax is Delayed!

This is the ninety-sixth issue in our health care reform series of alerts for employers on selected topics in health care reform. This series of Health Care Reform Management Alerts is designed to provide a more in-depth...more

Health Care E-Note - December 2015

A little-noticed provision in the federal Bipartisan Budget Act of 2015 calls for OSHA to increase its penalties to adjust for inflation for the first time since 1990. Please see full E-Note below for more...more

IREG Update - October 2015 #2

Hot Topic - The FIO's criticism of state regulators regarding captive reinsurance framework - The Federal Insurance Office in its September 2015 "Annual Report on the Insurance Industry" criticizes state insurance...more

Manatt on Health Reform: Weekly Highlights - October 2015 #2

Iowa's largest insurer joins the State's Marketplace for coverage year 2017; carrier changes are announced for Marketplaces in Kentucky, Oklahoma and Wyoming; and South Dakota's Governor convenes the Health Care Solutions...more

Manatt on Health Reform: Weekly Highlights - September 2015 #5

New study shows Marketplace premiums parallel the employer market; Montana likely to select a private insurer to administer benefits to its Medicaid expansion population; and Washington’s Exchange customers will begin paying...more

Excellus Blue Cross Blue Shield sued for data breach announced last week

Within days of Excellus Blue Cross Blue Shields’ (Excellus) announcement that its data had been accessed by a hacker through a “sophisticated” cyber-attack, two law firms teamed up to file a proposed class action suit last...more

10 Million Affected by Sophisticated Cyberattack

The latest major health insurance data breach of 2015 reported by Excellus BlueCross BlueShield is considered one of the top 20 worst reported breaches of a healthcare organization. The attack affected about 7 million...more

Blog: Excellus is Latest in Line of BCBS Insurers Experiencing Cyberattack

Excellus, a BlueCross BlueShield (BCBS) provider servicing upstate New York, announced last week that it was the latest in a string of BCBS providers that experienced a data breach as a result of a cyberattack. CareFirst...more

IREG Update - September 2015 #2

Hot Topic: Auto insurance in the age of the driverless car - Background - Not surprisingly, the most common cause of vehicle accidents is human error. Whether a motor vehicle offers one automated function or fully...more

Exellus BlueCross BlueShield – Latest Victim of a “Sophisticated” Health Plan Cyberattack

Exellus BlueCross BlueShield has announced that the personal information of at least 10 million members has been compromised in a “very sophisticated” cyberattack that occurred on December 23, 2013 and was discovered by the...more

10 million Excellus Blue Cross Blue Shield members’ information compromised

Yesterday, Excellus Blue Cross Blue Shield, located in Rochester, NY, announced that it will notify up to 10 million members that it was the victim of a cyber-attack dating back to December of 2013 that exposed their members’...more

Manatt on Health Reform: Weekly Highlights - September 2015

CMS permits states to use income information from other means-tested benefit programs for Medicaid eligibility determinations; Alaska’s Medicaid expansion is given the green light to launch today; and Washington State submits...more

Blue Cross of Northeastern Pennsylvania Denied Peer Review Protection

The Pennsylvania Superior Court has decided the Pennsylvania Peer Review Protection Act does not apply to alleged peer review activity conducted by Blue Cross of Northeastern Pennsylvania, because Blue Cross is not a...more

CareFirst BlueCross BlueShield sued for hacking incident

Not to be left out, plaintiffs filed suit against CareFirst BlueCross Blue Shield late last week for the hacking incident the insurer suffered in May, which resulted in unknown intruders gaining access to names, dates of...more

Changes to the Terms of BCBSM’s Administrative Services Contracts in the Wake of Hidden Fees Suits

Effective January 1, 2016, Blue Cross Blue Shield of Michigan ("BCBSM") will implement significant changes to the Administrative Services Contracts ("ASCs") issued to its self-funded customers. Notably, BCBSM has attempted to...more

Chasing Payments: District Court Holds that Providers Lack Standing to Sue ERISA Plans for Benefits if the Patients Remain Liable...

A district court in Tennessee recently rejected ERISA claims by healthcare providers against a plan insurer, holding that the providers lacked standing to sue under ERISA as their patients’ assignees. Brown v. Blue Cross...more

Investors Should Be Aware of an Interesting Blue Cross Antitrust Case

It was recently reported that Blue Cross and Blue Shield (BCBS), along with the Blue Cross Blue Shield Association, was sued across all states in a class action brought by two types of plaintiffs. One plaintiff class reflects...more

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